Critically Appraised Topic CAT - Children's Mercy Hospital

Critically Appraised Topic (CAT) PICOT Question: Insert the PICOT question, list the following components: Population, Intervention and Comparison (or Thing of Interest), Outcome, Type of Question

Should the use of probiotics be added to emergency room discharge teaching in the care of patients with upper respiratory infections?

Clinical bottom line based on literature appraisal below: Insert here to delineate the CMH&C practice implications

Best strain and best dose of probiotics still being evaluated. Need more research. Strongest data is prevention of illness rather than probiotics at this time.

Search strategy implemented: Insert databases searched and search terms used

Search terms used were probiotics, upper respiratory infections, pediatrics .Search engines Pubmed, Medscape, Web MD

Search outcome: Insert here to indicate the number of papers found; the number of papers, which are relevant, and the number of papers that were of insufficient quality to include in the synthesis

Numerous articles found on probiotics but 4 were relevant and reviewed my PICOT question.

Upon completion of the CAT please forward to Jackie Bartlett, EBPC Program Manager, at [email protected] EBP/@EBPC@/EBP Core/Toolkit/LiteratureSynthesis 10/08

Synthesis of relevant studies: Author, date, country, and industry of funding

Patient Group (insert below subject population)

Leyer, G, Li,S, Mubasher,M. Reifer,C, Ouwehand,A, 7/27/2009 China, Danisco USA Sponsored Study

326 Healthy children ages 3-5 years

Kotowska, M, Albrecht, A, Szajewska,H, 2005

269 children 6 months to 14 years of age with either otitis media or respiratory tract infection. All treated with antibiotics.

Thomas,D, Greer,F, Committee on Nutrition: Section on Gastroenterology, Hepatology,and Nutrition 2010 USA

Kemper, K. 2004 USA

Level of Evidence (insert below corresponding Oxford Level of Evidence)

Research design

Significant results

Limitations

prospective randomized double blind placebo -controlled study of 326 healthy children 104 placebo, 110 received 1 probiotic. 112 received combo of 2 probiotics

2 results found. Daily dietary probiotic supplements for 6 months was effective in decreasing uri's and duration of subsequent illnesses.Secondly,found combo of L acidophilis and B lactis had the best results for protection from illness

Failure to evaluate mucosal colonization , underlying mechanism, or the effect of probiotics in an acute response to s/s of illness.

2

randomized controlled trial

Randomized to have S. boulardii 250 mg or placebo bid for entire course of antibiotics. Results probiotic group3.4% had diarrhea compared to 17.3% of the placebo group. No adverse effects of probiotics given.

5 different antibiotics used for tx of the originating illness. Diarrhea could be from the antibiotic not sure that the probiotics were the reason that group had fewer s/e . or that it helped the uri.

201 infants 4-10 months of age

1

double blind, placebo controlled trial by Weizman et al.

Infants received probiotic supplemented formula with B. Lactis or L. Reuteri or a control formula over a 12 week period at 14 different child care centers over a 2 yr period. Results fewer diarrhea and shorter episodes found in probiotic group. no significant effect on the URI found in probiotic group.

Article notes Rotovirus vaccine will help the patients to not develop the acute infectious diarrhea than probiotics at this time. No significant effects on uri .

expert opinion

5

expert opinion . review of literature

No honey under 1 yr. for risk of botulism. Vit C. and echinacea can help reduce the risk of prolonged URI. No probiotics for immunocompromised pts discussed .Common sense care of pts discussed rest, fluids, good hygiene, and immunizations, and eating right .

Article concludes that more research on dose and combination of probiotics needed

1


Commentary: (Insert below the thought processes involved in ascertaining the clinical bottom line)

After review of recent literature we should not routinely begin to include probiotics for our emergency room discharge instructions for our patients with upper respiratory infections in particular. It is not clear the dose or strain to use and further study is needed if probiotics help in treatment of upper respiratory illness.

Authored by: (Insert below the author name(s) and credentials)

Audrey McCullough RN,BSN,CPN on 9/23/11

Date created: (Insert below the date the CAT was created)

9/23/11, revised 10/24/11. References: APA and MLA examples found at OWL (Online Writing Lab) at Purdue. (Uses APA or MLA Format) Buck, M.(2009).Saccharomyces Boulardii as a Probiotic for Children. Medscape Medical News. www.medscape.com/view article/707760. Retrieved 9/25/2009 from WebMD. Kemper, K.(2009). Complementary and Alternative Medicine Therapies for Cold and Flu Season: What is the Science? Medscape Medical News . www.medscape.com/viewarticle/711485. Retrieved 9/16/2011 from WebMD. Leyer, G.J., Li, S., Mubasher, M.E., Reifer, C., Ouwehand,A.,C., (2009). Probiotic Effects on Cold and Influenza -Like Symptoms Incidence and Duration in Children. Pediatrics,124,e172-e179. doi:10.1542/peds2008-2666. Thomas,D.,W., Greer,F.,and Committee on Nutrition:Section on Gastroenterology, Hepatology, and Nutrition; (2010). Probiotics and Prebiotics in Pediatrics. Pediatrics,126;1217.doi:10.1542/peds.2010-2548.
